Healthcare acquired infections are defined by the Center for Disease Control and Prevention (CDC) as infections acquired by patients while receiving treatment for another condition in a health care setting. These infections are caused by a variety of bacteria, viruses, fungi, and other pathogens that primarily affect immunocompromised and elderly people, especially if the causative organism has developed resistance to a number of antimicrobial agents (3, 31-35). Healthcare acquired infections account for about 100,000 deaths and anywhere from $28.4-45 billion a year in medical-related expenses in the United States, and it is estimated that hundreds of millions of patients around the world are affected by health acquired infections each year (1). Although these infections are costly and deadly, they are preventable and efforts to maximize the efficiency of prevention efforts across the United States are being coordinated by the U.S. Department of Health and Human Services (2, 36, 37).
Transmission of healthcare acquired infections is most commonly associated with invasive medical devices or surgical procedures that result in central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia (3). However, healthcare acquired infections (HAI) are also transmitted by contaminated uniforms, scrubs, and coats worn by health care workers, such as physicians and nurses. Despite their best intentions, health care workers unknowingly act as vectors to various bacteria and pathogens that come into contact with their apparel, causing cross-contamination and the spread of healthcare acquired infections in patients (21). Studies have implicated the coats of health care workers for being contaminated with bacteria responsible for the development of healthcare acquired infections (4-24). This includes bacteria like methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, vancomycin-resistant enterococcus (VRE), carbapenem-resistant enterococcus (CRE), etc. (4-24).
One of the main reasons for this problem is that the coats and other apparel worn by health care workers are not laundered as often or as effectively as they should be (7). The current procedure used by hospitals to clean white coats and/or uniforms is to launder them either on-site or off-site using laundry facilities, following the regulations proposed by the CDC (38). However, laundering coats and other healthcare worker apparel on a daily basis places an inefficient and expensive burden on hospitals. In a cost-saving effort, hospitals commonly allow health care workers to launder their own uniforms, white coats and even operating room scrubs at home (26). However, domestic laundering practices differ greatly from industrial laundering practices (40, 41). As a result, this cost-saving effort has been shown to lead to the contamination of home laundered uniforms with one or more pathogens before the start of a healthcare worker's shift (42). In one study, scrub contamination of at least one of the test organisms increased to 54% at the end of shifts. Also, VRE was found on 31% of uniforms, C. difficile on 19%, and MRSA on 15% (42). Similarly, another study isolated pathogens from 48% of hospital gowns (43). A significant increase in total bacteria from the beginning to the end of a work shift was found, with average counts increasing from 2.2 CFU/cm2 to 4.9 CFU/cm2 (43).
Even though some hospitals provide excellent laundering facilities, health care workers tend to not use these services regularly. A recent study at the University of Maryland reported that about 65% of the health care workers washed their coats less than once a week and 15% less than once a month (21). Implementation of effective laundering practices is often hindered by a lack of support from administrators and poor compliance by doctors, nurses, and other health care workers. Some health professionals believe that their apparel is clean and sterile when it is not. Many are visibly upset when their poor hygiene practices are exposed and are offended when it is suggested that they may be potential vectors of disease and are spreading virulent microorganisms among their patients (44).
Further, as laundering of apparel is the primary procedure followed in healthcare settings for disinfection, the ability to provide quick disinfection of coats, uniforms, scrubs, and other objects and apparel used in the healthcare environment suffers from a lack of available technology. Due to the concerns arising from the spread of healthcare acquired infections by apparel worn by healthcare workers, the United Kingdom's Department of Health recently recommended that hospitals adopt a “bare below the elbows” dress code and that white coats be disallowed in an attempt to decrease the transmission of bacteria (20, 39). This recommendation reflects the seriousness of this problem but does not adequately address the spread of infection by contaminated apparel. While bare below the arms policy reduces the spread of pathogens by the sleeves, the unhygienic habit of not washing health care apparel on a daily basis still spreads diseases. Thus, there remains a need for a viable source of disinfection in healthcare facilities that will complement the existing efforts to reduce healthcare acquired infections. The present invention fulfills this need as well as other needs.